Thursday, June 20, 2019

Fiat Lux: Let there be light

Fiat Lux, Latin for “Let there be light,” is the motto of the University of California. It is also an ancient biblical reference that announces the coming of light into the world and, with it, knowledge, the power of perception and the hope for wisdom.

Early Judo-Christian belief was there was a bone somewhere in the human body which held spiritual importance and was the means of resurrection. God was thought to look after it and made the bone indestructible.Emperor Hadrian (AD 76 -138) was aware of the common belief but was sceptical until he was shown proof.

It took until the writings of Rabbi Uschania (AD circa 210) to affirm the bone could not be destroyed by fire, water or other element. The bone was thought to be completely unbreakable, nor would it bruise even under force. Many historians believe the holy bone existed somewhere in the spinal column and was called Lus (or lux - Aramaic). However, not all agree which part of the column the bone came from (i.e. top or bottom) and some believe Lux may have referred to the talus (in the foot).

The talus is rather unique in the body as it is the only bone which has no muscles originate from it nor attached to it. The bone sits beneath the tibia and on top of the calcaneum e.g. between the leg and foot. It has a very important function which allows the foot to adjust to the ground and helps the upper skeleton compensate.

(Video Courtesy: DrGlassDPM by Youtube Channel)

The talo-calcaneal, or subtalar joint allows three dimensional motion to occur i.e. supination and pronation.

In antiquity dice were made from the talus of hoofed animals, like oxen. They were referred to as ‘c” and had a tetrahedral shape. The Dice (often called bones) were used for games and throwing dice for money was the cause of many special laws.

At the Crusification, the centurions diced at the feet of Christ,(Matthew 27:35-40). Despite the association with gambling the talus, was known as the good bone and the Centurions using it as a dice, might be taken to represent reserection. Good men never die.

Reviewed 20/06/2019

Wednesday, June 19, 2019

Callus or callous?

Probably never crossed your mind the grammatical difference between 'Callus' and 'Callous', The terms are used synonymously to described localised hyperkeratosis, but should they be used in this way is the burning question on the lips of many. The origins of both words derive from the Latin word 'callum' meaning, hard skin, and are the masculine form. Middle English, from the Old French word 'cailleux', meaning hard skin. They first appeared, as a variant, in the English language in and around the 16th century, just as corn cutters were becoming popular in Europe and Britain.

During the pox epidemics of the Middle Ages physicians were at a loss to treat open sores common to syphilis (large pox), small pox and Hansen's Disease. Lack of understanding meant many doctors refused to treat patients suffering from venereal diseases and hence this sector of the population sought alternative medicine and occult remedies. Many claims corresponded to disease remission as the disease process ran its course to secondary and tertiary stages. Among this ground swell the corn cutter emerged. During this time the Quack Act (England)was introduced which allowed non-medical persons to be legally able to treat open sores with almost anything and everything that made the patient better. Scathingly medical practitioners referred to these alternative persons as 'quacks' and hence the Quack Act.

The word "quack" derives from the archaic word "quacksalver", of Dutch origin (spelled kwakzalver in contemporary Dutch), literally meaning "hawker of salve". In the Middle Ages the word quack meant "shouting". The quacksalvers sold their wares on the market shouting in a loud voice.

To them callus (singular noun) described and area of thickened skin or area of bony tissue formed during the healing of a fractured bone. The plural version was calluses.

As a verb, to callus means to produce or cause thickening of the tissues. Inflected forms of the intransitive verb would be callused, callusing, and calluses. Callous meantime is not a noun but an adjective meaning unfeeling and insensitive. When used to describe callus it means skin that has hardened and thickened. The term callous can also be used as a verb to describe the pathological processes involved in producing callus (es). The intransitive, inflective version of the verb being calloused, callousing, and callouses. All meaning to make or become callus. So as a footnote to this piece allow me to demonstrate correct usage. Do not confuse the adjective callous, as in

"Years of dealing with self centered, self opinionated, patients with self inflicted injuries has left me callous, with the thought of the callus(es) and corns on the soles of their feet."

Also, do not confuse the verb callous, which means “to make or become callous,” with the verb callus “to form or develop hard skin.”

Reviewed 19/06/2019

Shaq's shoes

Basketball legend Shaquille O’Neal is 2.16m tall and weighed approx., 145kg during his 20-year NBA career. Now retired, he works on television and recently decided to show off his size-22 feet. Not a pretty sight.

Something any collector would love however, are Shaq’s shoes.

(Video Courtesy: TopStats by Youtube Channel)

Reviewed 19/06/2019

Tuesday, June 18, 2019

Women’s feet, soccer boots and common injuries

Soccer is the world’s most popular organised sport with over 265 million males and 34 million females registered with the Fèdèration Internationale de Football Association (FIFA). The popularity of soccer among girls and women in all parts of the world is on the increase at a time when some claim the continued absence of gender specific soccer boots creates multiple problems, injury, and reduced participation for women soccer players. According to (Wunderlich and Cavanagh , 2001) there are sufficient anthropometric foot variations to make the present practice of down-sizing men’s boots potentially hazardous for women players.

Men have longer and broader feet for a given stature and according to Wunderlich and Cavanagh (2001) there are two calf, five ankle, and four foot shape variables, in men and women’s feet. They discovered gender differences in the navicular height at the arch, the lateral side of the foot, the first toe angle, and the girth of the forefoot at the ball of the foot. Women’s feet generally have a narrower heel (where the shoe grips the back of the foot), a wider forefoot causing them to currently prefer smaller fittings to accommodate the heel and, higher arches and a significantly pressure load under the foot caused by their wider hips. This study highlighted female feet and legs were not simply scaled-down versions of male anatomy but rather differ in a number of shape characteristics. These differences, they author claim should be taken into account in the design and manufacture of women's sport shoes.

Most reported injuries (60%) in women’s soccer are located in the lower extremities (Junge and Dvorak, 2007). Female soccer players risk knee and ankle injuries with Anterior Cruciate Ligament (ACL) injury four times more frequently than their male counterparts. According to published data the majority of ACL injuries occur in non-contact situations. According to the NCAA, women soccer players have the third-highest ACL injury rates in NCAA sports behind men’s spring football and women’s gymnastics. The most frequently diagnosed injuries were ligament (ankle) sprains (25.7 percent), followed by muscle strains (21.5 percent), contusions (15.9 percent) and concussions (9.2 percent). Women soccer players were nearly three times more likely to be injured in a game (14.4 injuries per 1,000 athlete exposures) than in practice (5.0 injuries per 1,000 athlete exposures). Pre-season has the highest overall injury rate (9.1 per 1,000 athlete exposures), while the post-season has the lowest (3.8 per 1,000 athlete exposures) as compared to the in-season injury rate of 6.8 injuries per 1,000 athlete exposures. Contact with other players accounted for the majority of injuries. The most common activity at the time of injury during competition was general play (30.8 percent), followed by defending (16.0 percent), heading (10.1 percent), ball handling and dribbling (9.7 percent), loose ball (8.1 percent) and goaltending (6.6 percent). The action of heading the ball ranks sixth as the most common activity at the time of injury. Although a player's age may not affect injury characteristics such as such as type, body location, and severity, the longer you play and the more training you do, does increase the potential to injury . Research confirms, higher game injury rates in male soccer and these have been attributed to greater physical intensity of play during games.

The aetiology of soccer injuries is multi-factorial and “intrinsic” factors such as general condition, muscle tightness should be distinct from “extrinsic” factors such as weather conditions and playing surfaces etc. There are however, some indications suggesting a link between footwear and ACL injuries. The most common mechanism of a non-contact ACL rupture is a deceleration event and a sudden change in direction with a planted foot (i.e. cutting manoeuvre). At the end of the last millennium Asics developed an innovative cleat designed to help prevent rotational collateral damage to the knee, reported in Australian Rules Footie players. The prototype shoes soon became popular with other football codes including Australian soccer players. The Asics system allowed optimal traction without hindering the player from running freely on hard or artificial surfaces. Similar cleat patterns were incorporated within contemporary soccer boot design but increasing reports of players misusing their cleats to damage opposition players meant the innovation had a brief run before traditional stud patterns once again prevailed.

Del Coso J, Herrero H. and Salinero JJ 2018 Injuries in Spanish female soccer players Journal of Sport and Health Science Volume 7, Issue 2, pp 183-190
Giza E, Mithöfer K, Farrell L, Zarins B, and Gill T 2005 Injuries in women’s professional soccer British Journal of Sports Medicine 2005;39:212-216.
Junge A and Dvorak J 2007 Injuries in female football players in top‐level international tournaments Br J Sports Med; 41(Suppl 1): i3–i7.
Mufty S, Bollars P, Vanlommel L, Van Crombrugge, K. Corten K , Bellemans J 2015 Injuries in male versus female soccer players : Epidemiology of a nationwide study Acta Orthop. Belg., 81, 289-295
Brookshire B. Ottwell E. 2016 Women in sports are often underrepresented in science Studies of competitive sports and exercise are still dominated by men Science News
Sentsomedi KS, Puckree T 2016 Epidemiology of injuries in female high school soccer players Afr Health Sci. 16(1): 298–305.
women’s soccer injuries Data from the 2004/05-2008/09 Seasons NCAA
Vojdinoski C 2019 Melbourne startup Ida Sports is on a mission to create the ideal football boots for women
Wunderlich RE, Cavanagh PR 2001 Gender differences in adult foot shape: implications for shoe design Med Sci Sports Exerc. 2001 Apr;33(4):605-11.

Shoe Allergies

Shoe allergies are a form of dermatitis caused skin contacting allergens (irritants) in shoes and socks. Symptoms include inflammation, burning sensation, blisters, itching, fissuring (cracks in the skin) and sometimes secondary infection. Long term exposure to an allergen may result in the skin becoming thick, red and scaly. The allergic reaction is usually confined to the tops of the foot and toes but can also be found on the sole of the foot, the legs, and the sides of the feet and heels. There are many chemical substances in shoes and socks which cause allergies. Glues (para-tertiary butylphenol formaldehyde resin (PTBP-FR), and colophony); leather chemicals (potassium dichromate); rubber chemicals/accelerators (2-mercaptobenzothiazole (MBT) and thiuram mix chemicals); dyes (particularly PPD) ; and metal components/decorations on shoes (nickel sulphate and cobalt chloride) are all potential sources. There is no mechanism for de-sensitising to rosin. Once the dermatitis appears on the skin, treatment is as for any acute dermatitis/eczema, i.e. topical corticosteroids, emollients, treatment of any secondary bacterial infection.

The best way to avoid allergy is by being aware of products that contain the product. Look for the list of ingredients on the product labels or packaging of all substances you come into contact with, not just the ones you think you might be sensitive to. When this information is not often available on labels you may need to contact the manufacturer of the product or cosmetic for advice. However sensible and practical this advice is, it is often complicated because many of the products go under different names and there is a general lack of product information at the point of purchase. This is more difficult with footwear as the relevant information is rarely displayed.

Most countries now have a system called Material Safety Data Sheet (MSDS). MSDS (Material Safety Data Sheets) system catalogues information on chemicals, chemical compounds, and chemical mixtures. MSDS information may include instructions for the safe use and potential hazards associated with a particular material or product. There is a duty to properly label substances on the basis of physico-chemical, health and/or environmental risk but the MSDS is not primarily intended for use by the general consumer. The focus is primarily on the hazards of working with the material in an occupational setting. When no information available and direct inquiry to the product manufacturer is required.

Colophony (rosin) is the yellow/black sticky sap which comes from pine & spruce tree trunks. When it is distilled it is used to produce turpentine and gum, the latter is widely used in every-day products from personal care and beauty products, topical medications, cosmetics, adhesives and sealants, chewing gum to shoe glue and boot polish. Rosin is also used for its friction-increasing capacity including ballet and flamenco dancers rubbing their shoes in powdered rosin to reduce slippage on stage. Violin and banjo players use it to prevent the bridge from moving during a performance. You will often see clouds of it used by gymnasts and competition weight lifters to improve their grip. The list is almost endless but despite its usefulness Colophony also causes Allergic Contact Dermatitis (ACD) and Occupational asthma. Skin contact in some people causes a dermatitis with the typical symptoms of redness, swelling, itching and fluid-filled blisters. Because of the ubiquitous nature of rosin in our every day lives people with allergies have major challenges trying to avoid contact which often means reading labels very carefully and looking for products which contain the irritant or related chemicals. Rosin is also known by several other names, including: Resin terebinthinae, Tall oil, Abietic acid , Methyl abietate alcohol, Abietic alcohol and Abietyl alcohol.

(Video Courtesy: SPdermatology by Youtube Channel)

Footnote If you have any of these symptoms then please consult your physician for assistance.

Interesting sites
Shoe allergies: A resource for those who have allergies to their shoes

Reviewed 18/06/2019

Monday, June 17, 2019

Itchy Feet: Shoe allergens

The manufacture of modern shoes is complex and most consumers remain unaware of the chemicals used in their preparation. Shoes are constructed with various materials glued together with different adhesives, all these steps involve chemicals that can cause sensitization and footwear allergy. The common rubber allergens are phenolic resins, thioureas, carbamates and additives.

Diagnosis is frequently hampered because presenting symptoms can be obscured as shoe allergy can mimic other dermatoses of the feet e.g. atopic dermatitis, or chronic itchy inflammation of the skin which is common in people who have hay fever or asthma.

Contact dermatitis may appear in acute, subacute, intermittent or chronic forms and many of the constituents of shoes, such as rubber, adhesives, chemicals used in tanning leather, dyes, biocides and trim, can all be the source of skin irritation. The hot humid environment within the shoes also gives an ideal environment for contact dermatitis.

Sometimes metal buckles or shoelace grommets made from nickel may also cause contact allergy. Research has shown rubber chemicals are the most common culprit in shoe-related allergies and subsequent skin irritations usually are confined to a specific area with clearly defined boundaries. The allergy can cause red and swollen skin that may blister. There are two types of contact dermatitis.

In the irritant type, exposure to substances such as soaps, detergents or metals may irritate the skin.

In the allergic type, exposure to a substance is the cause, but the initial exposure or even numerous subsequent exposures will not cause an allergic reaction. Allergic contact dermatitis of the foot develops over time, as the skin of the foot is repeatedly exposed to an allergen (the substance that causes allergic reaction). In some cases this may take years. The pattern of shoe dermatitis usually corresponds to the location of the offending substance in the shoe. Shoe dermatitis is usually symmetrical (same pattern on both feet) but may also be patchy and or unilateral (one foot).

Allergies on the top of the foot may be caused by allergens in glues or chromates and vegetable tannins in leather, or synthetic materials like polyurethane or neoprene foam. Leather traditionally is chrome-tanned, exposing the wearer to potassium dichromate. Tanning is followed by oiling, dyeing and finishing which give an attractive but tough outer coat to the leather. Shoe counters and toe boxes which give shape and support to shoe contain a number of allergens like adhesives and biocides.

Dermatitis on the sole of the foot may be due to rubber or other materials in the insole, lining or glue which holds these two layers in place. Adhesives like hot melts, urethane, neoprene and natural rubber (latex) all cause allergies and various substances like p-tert-butylphenol-formaldehyde resin (PTBP-FR), colophony and epoxy resins impart allergenicity to these adhesives. Sport shoes are frequently implicated in shoe allergy as are work shoes and footwear that keep the feet warm.

In the US reports of eczema caused by contact with insoles in Nike shoes have been on the increase. Wearing socks may temporarily reduce the risk but often it is necessary to patch testing for allergens. This involves cutting up the shoes into small pieces and testing them against the person’s skin for 24 hours. The tape strips are removed and the skin inspected for reaction, such as a small red spot that appears at the patch site. Once identified the cure often involves a complete change of footwear. Depending on the cause, will determined whether all leather shoes or synthetic or hemp or vegetable–tanned leather footwear is recommended. In cases where dermatitis was confined to the soles of the feet, replacing the insoles with felt or cork might suffice.

Sandals are less often associated with shoe allergy. Their open design allows feet to "breathe," and with no foot cover there is little material to irritate the feet.

This does not constitute actual medical advice and is posted in the interests of information share. If you have any of these symptoms then please consult your physician for assistance.

Interesting site
Shoe allergies: A resource for those who have allergies to their shoes

(Video Courtesy: Billings Clinic by Youtube Channel)

Reviewed 17/06/2019

Tuco's Cousins' Salamanca skull lucchese boots

Tuco's Cousins' Salamanca skull lucchese boots from the Breaking Bad TV show.

(Video Courtesy: Tuco Salamanca by Youtube Channel)

Sunday, June 16, 2019

Pause for thought

Foot orgasm syndrome

Foot orgasm syndrome (FOS) is a rare condition in which the patient may experience sensations similar to those experienced during sexual activity on stimulating the foot. It was first documented in a 55-year old woman from the Netherlands. The woman reported several orgasms a day triggered from the left foot, without being sexually aroused and started to experience the syndrome 18 months after an intensive care emergency. After extensive tests and injecting the anaesthesia into the left S1 dorsal root ganglion that receives sensory information from the foot, doctors were able to cure the patient of her embarrassing problem. The footgasm case is published in the medical journal, Journal of Sexual Medicine.

No one is exactly sure why these neural reflexes arise but some experts suggest the peri-orgasmic phenomena, arose 18 months after an intensive care emergency. Subsequent axonotmesis or partial nerve regeneration combined with afferent (C-fibre) information from a small re-innervated skin area of the left foot and afferent somatic and autonomous (visceral) information from the vagina on at least S1 spinal level was misinterpreted by the brain as coming from the genitals only. The sensory nerves of the foot and the genitalia enter the spinal cord at the same level. Neural print through may account why sometimes the brain misinterprets this information.

A recent published study of the human orgasm demonstrates a core set of physiologic and psychological symptoms experienced by most individuals. Within the range of behaviours there were some unusual physical and psychological symptoms (or peri-orgasmic phenomena) experienced by some individuals in association with orgasm. These phenomena are rare and documentation in the medical literature is largely confined to case studies.

Reinert AE, Simon JA. 2013 "Did You Climax or Are You Just Laughing at Me?" Rare Phenomena Associated With Orgasm. Sex Med Rev pii: S2050-0521(17)30034-3. Waldinger MD, de Lint GJ, van Gils AP, Masir F, Lakke E, van Coevorden RS, Schweitzer DH. 2013 Foot orgasm syndrome: a case report in a woman. J Sex Med. 10(8):1926-34.

Reviewed 16/06/2019

Saturday, June 15, 2019

The Humble Foot Rub: Please explain?

Stimulation of the skin and connective tissues by mechanical means is likely to be one of the first medical treatments to be discovered and foot massage was certainly known to the ancients. We all do it, and even word ‘shampoo.’ means to massage and derives from the Hindi word, chāmo.

Shampoo bath houses were introduced to England in 1759 when Bengali entrepreneur Sake Dean Mahomed, opened 'Mahomed's Indian Vapour Baths' in Brighton. He was appointed ‘Shampooing Surgeon’ to both George IV and William IV.

In Biblical Times foot washing was a sign of friendship and ceremonially undertaken when guests came to visit. Foot washing (and massage) was usually done by the lowest servant and considered an act of humility.

Message has been a feature of both occidental and oriental societies for centuries but had its renaissance in the US, in the middle of the 19th century. Advancement in modern pharmaceuticals eventually saw medical massage finally subside but it was popular during the thirties for treatment for polio and again later on the 20th century with the rise of sport and alternative therapies.

The term message became associated with sexual services after the Second World War when it became obvious massage was a masquerade for sexual services when it became illegal to advertise offers of sex. Foot massage can be most sensual but no one can be sure how it works. Some experts believe it blocks pain signals to the brain which in turn activates the parasympathetic nervous system, stimulating the release of endorphins and serotonin.

The benefits of massage include pain relief and stress reduction and studies in aromatherapy message, indicate the immune system is stimulated which increases the peripheral blood lymphocytes (PBLs) to help clean up the system.

Aromatherapy massage includes the use of sweet almond oil, lavender oil, cypress oil, sweet marjoram oil, and other oils such as neroli oil and pine oil mixed with carrier oils. Many other oils can be used including fractionated coconut oil, grape seed oil, macadamia oil, sesame oil, pecan oil, and mustard oil.

Another common practice is to use Arnica oil, made from the flowers or leaves of the Arnica montana. The use of oils, creams, or lotions help reduce friction over the skin which allows the masseur to apply smooth strokes. There are over 80 different types of massage but the more common modalities include: Acupressure (Reflexology), Shiatsu, Tui Na, Thai Massage and Barefoot Deep Tissue.

Reflexology, also called Foot zone therapy, is traditionally practiced without lotion, as the pressure points on the feet are stimulated by thumb and finger walking, as well as static pressure. Reflexology is similar to acupuncture (although the former involves pressure rather than puncture) and both are based on Chi or the energetic flow of "meridians" in the body. Like nerves these form pathways along the body and fingers and toes represent the beginning and end. With Reflexology ‘painful spots’ on reflexology points indicate illnesses of other parts of the body. As pressure is applied a healthy patient should not feel strong pain. The therapy involves finding the ‘ouch spots’ and applying gentle pressure.

Shiatsu massage originated as a form of Anma from China which was introduced to Japan about 1300 years ago. Anma is based on kneading movements and Shiatsu uses thumb pressure and works along the same energy meridians as acupressure but incorporates stretching.

Another form of Anma is Tui na which uses acupressure and is a modality of Chinese medicine to bring the body into balance. The practitioner may brush, knead, roll/press and rub the areas between each of the joints (known as the eight gates) to open the body's defensive (wei) chi and get the energy moving in both the meridians and the muscles. The practitioner can then use range of motion, traction, massage, with the stimulation of acupressure points and to treat both acute and chronic musculoskeletal conditions, as well as many non-musculoskeletal conditions.

Thai Foot Massage is used on the lower legs and feet to “open” Sen (energy) lines and is combined with the use of a stick to stimulate the reflex points on the feet. Please note if you are unfamiliar with local custom when in Asia ensure you receive the right attention by asking for an ‘old lady massage.’ Thai massage is often used as a euphemism for a sexual service, so unless you require a "young lady massage," caution is necessary. In Asia foot message is frequently a service offered in the street by blind people. Chavutti thirummal is a traditional form of massage from India which involves the therapist suspending themselves form a rope attached to the ceiling. They then use their feet to manipulate their client’s body. A more recent adaptation is Barefoot Deep Tissue, where the barefoot therapist uses their bare feet instead of their hands to apply a broad range of pressure with ease regardless of client's size or build. Deep tissue techniques are generally used when working on a specific joint, muscle or muscle group, the practitioner can access deeper layers of the soft tissue.

This technique is similar to Myofascial Release which involves the hands.

These ancient forms of massage should not be confused with ‘tramping’ which is altogether different and involves standing on the human body (with or without shoes). Tramping is practised by some S&M enthusiasts. For some people a foot massage can be highly sexually charged thought to be due to the sensory nerve supply to the feet and genitalia lying adjacent in the brain. This means that ‘tickling’ the feet can have the same effect as ‘tickling your fancy’ (or genital masturbation).

A foot massage can last up to 90 minutes and should be completed with a pedicure (or as foreplay). A loving foot massage should be preceded by a foot spa in lukewarm water mixed with a handful of table salt (or oils of choice). Keep the feet immersed for no longer than 10 minutes then dry them thoroughly with a soft towel. Make sure to dry gently between the toes.

The foot massager should sit with a pillow or folded towel in their lap and topped with a hand towel. The hands are rubbed with massage cream to warm them (avoid greasy oils as the hands get slippery and it is difficult to apply pressure). Never apply the creams directly to the feet only the hands. Have your partner sitting in a relaxed position with knees bent, and feet in your lap. You can with work on one foot at a time or both feet. When you are working on one foot, keep the other warm by draping it with a towel.

Foot pad and arch massage
Place fingers lightly across top of toes, thumb against the sole. Use your thumb to press in a circular motion. Continue the circular motion as your hand moves across the foot in a horizontal path. Removing your fingers from the top of the toes, slide your hand slightly closer to the arch and repeat the side-to-side massage. Continue until you have massaged the area under the instep. Work the bones by pressing down with the thumb and heels of the hands, and up and in with your fingers.

Toe massage
Starting with the 4th toe rub each toe between fingers and thumb, pulling up gently, then press the flesh between the toes. Hold the heel firmly with one hand and use the other hand to push the toes forward and backward. Hold the stretch for several seconds each way, then repeat. Gently tug each toe with your index finger and thumb. Then, starting with the big toe, twist each toe from side to side; let the thumb and forefinger slide off the end. Never crack the toe knuckles.

Heel and ankle massage
Support the heel with your cupped hand and move your thumb in a circular motion around the heel pad, applying increasing pressure. Finish by pinching behind the ankle several times. Run your fingers along the top of the foot, then stroke the entire area from foot to knee. Repeat, more gently each time, until done. Starting at her heel, slide both thumbs up and out to the outside toes. Repeat, each time with a slightly narrower V, until your thumbs meet. If the person is ticklish, use more pressure. When your thumbs are about to give out, use the knuckles of your first two fingers to make small circles on the heel and ball of her foot. Hold the foot loosely with both hands like you would a baseball bat, then rotate them like you're wringing a towel.

The three techniques may be repeated as desired.

Please note the details above represent information only and should not be taken as actual instruction. Foot massage is a relaxing event but not everyone will benefit. You should first check with your doctor/foot physician and then seek out the professional services of a licensed massage practitioner.

Reviewed 15/06/2019